What could cause high diastolic blood pressure?

Question

Hello doctor,

I am a 38-year-old female with a history of SVT (supraventricular tachycardia) and cardiac ablation. I have been smoking for 25 years, and my height is 5 feet 4 inches with a weight of 175 pounds. Yesterday, I experienced pain in my jaw and left shoulder. I checked my blood pressure, and it was 150/105 mmHg. This persisted for about three hours, after which I went to the ER. They performed a CBC and a Toronto pen test, both of which came back negative. The EKG was also negative. My blood pressure seemed to stabilize when lying down, but upon standing, the diastolic number continued to be in the 90 and 100. I was sent home with a diagnosis of anxiety.

Today, my blood pressure has been fine until about two hours ago, when I once again experienced jaw pain and pain in my left shoulder. I checked my blood pressure, and the systolic was 138, but the diastolic was 99. The diastolic pressure has remained high over the past two hours. I am not experiencing anxiety. I have no history of high blood pressure and do not take any medications, except for Esomeprazole 40 mg.

Is it acceptable for the diastolic number to be this high?

Answer 1

Hello,

Welcome to icliniq.com.

It is elevated. Our target is to keep it below 90. However, it is acceptable to have it higher if the systolic remains well controlled, as there is no definitive evidence of excessive risk from a higher diastolic on its own. That said, we aim to keep it below 90. Now, some possible reasons in your case: First, do you still smoke? Do you snore at night? Is there any history of disrupted sleep, morning headaches, etc.? Do you have a history of gastritis, chest burning, or nausea? These could suggest gastroesophageal reflux as a possible cause of your symptoms.

Here are the possibilities I am considering:

Being overweight can raise diastolic blood pressure. A healthy lifestyle, regular exercise, and weight loss can help bring it down. Additionally, a low-salt diet may be beneficial.
You should continue monitoring your blood pressure three times a day for a week (resting BP). If it remains elevated, it may be worth considering a low-dose angiotensin receptor blocker.
There is also a possibility of obstructive sleep apnea due to being overweight. This can increase sympathetic tone and raise diastolic blood pressure.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

We have reasons for all of your symptoms. So, try to modify your lifestyle. Reducing smoking and achieving weight loss will truly help with many issues. It is not an emergency, as the possibility of a heart attack has already been ruled out. Just continue to monitor your blood pressure. Generally, diastolic hypertension is not an emergency, but if the systolic blood pressure goes above 180, it becomes an emergency.

Thanks and regards.